Death is ill-planned, report says
Experts say many people undergo costly and unwanted end-of-life treatments.

By Matt Sedensky
Published: September 8, 2014

WEST PALM BEACH, FLA.— Americans suffer needless discomfort and undergo unwanted and costly care as they die, in part because of a medical system ruled by “perverse incentives” for aggressive care and not enough conversations about what people want, according to a report released Wednesday.

Though people stress a desire to die at home, free from pain, the opposite often happens, the Institute of Medicine found in its “Dying in America” report.

Most people do not document their wishes on end-of-life care, and even those who do face a medical system poorly suited to give them the death they want, the authors found.

The result is breathing and feeding tubes, powerful drugs and other treatment that often fails to extend life and can make the final days more unpleasant. The report blamed a fee-for-service medical system in which “perverse incentives” exist for doctors and hospitals to choose the most aggressive care; inadequate training for those caring for the dying and physicians who default to life-saving treatment because they worry about liability.

“It’s not an intentional thing. It’s a systemic problem,” said David Walker, the former U.S. comptroller general, who was co-chairman of the committee that issued the report.

The 500-page paper authored by 21 experts urged repeated conversations about patients’ wishes beginning far earlier than many would think – perhaps as teenagers – and continuing talks throughout life.